Surgical management of 58 patients with placenta praevia percreta

Abstract

Caesarean hysterectomy for placenta praevia percreta is associated with increased maternal morbidity. However, preoperative diagnosis of placenta praevia percreta, ultrasound mapping of the placenta, and the presence of a multidisciplinary experienced team may decrease maternal morbidity and mortality. Moreover, the urinary system may be protected in the patients with placenta praevia percreta without serious morbidity.

Case series of outcomes of a standardized surgical approach for placenta percreta for prevention of ureteral lesions

“…noted a median of 1 unit of transfused PRBCs in their series; however, only 19 (44%) patients had placenta percreta in their group. The present results are more comparable to those of Camuzcuoglu et al., who reported a mean of 2.7 units of transfused PRBCs for a 58‐patient series . The higher number of transfusion units in the present series might be related to the fact that the anesthesiologist protocol consists of transfusing patients in a prophylactic manner.…”

FIGO consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management,

“…If the placenta is anterior and extending toward the level of the umbilicus, and/or a hysterectomy is planned, a midline skin incision allows for a high upper‐segment transverse uterine incision above the upper margin of the placenta or more commonly a fundal transverse hysterotomy for delivery of the infant. Thus, a midline incision is recommended by most authors for PAS disorders diagnosed prenatally or at the time of cesarean delivery . The Joel‐Cohen incision (4–5 cm widths above the pubic symphysis) or a Cherney extended transverse incision (transection of the rectus muscles at their insertion on the pubic symphysis or a vertical incision of the fascia abdominalis) could be used to avoid a vertical incision or allow increased visibility, but there are no available data on the use of these types of incisions in the management of PAS disorders.…”

“…The main risk associated with any form of PAS disorder is massive obstetric hemorrhage, which leads to secondary complications including coagulopathy, multisystem organ failure, and death [9][10][11][12][13][14][15][16][17][18][19][20] (Table 1).…”

“…Different centers have published varying protocols with recommendations ranging from 34 to 36 weeks to 36-38 weeks of gestational age for planned delivery. [9][10][11]15,18,28,29 The majority of cases of PAS disorders are now associated with placenta previa, 13,14 and thus as gestational age increases the likelihood of major prepartum hemorrhage increases.…”

“…If the placenta is anterior and extending toward the level of the umbilicus, and/or a hysterectomy is planned, a midline skin incision allows for a high upper-segment transverse uterine incision above the upper margin of the placenta or more commonly a fundal transverse hysterotomy for delivery of the infant. Thus, a midline incision is recommended by most authors for PAS disorders diagnosed prenatally or at the time of cesarean delivery 11,15,18,35,46.…”